FORM NO.

16
PART B
Certificate under Section 203 of the Income-tax Act, 1961 for tax deducted at source on salary

Certificate No. AGIQWTA Last updated on 10-Jun-2022

Name and address of the Employer Name and address of the Employee
STATE BANK OF INDIA
3RD FLOOR SBI BHAVAN CC, MADAME CAMA ROAD, NARIMAN
POINT, MAYURI SAIKIA
MUMBAI, MUMBAI - 400021 PANORAMA APARTMENT, A BLOCK FLAT NO-204,
Maharashtra CHANDMARI, GUWAHATI - 781003 Assam
+(91)22-22740340
tds.frt@sbi.co.in
PAN of the Deductor TAN of the Deductor PAN of the Employee

AAACS8577K MUMS86151C EZLPS3057P

CIT (TDS) Assessment Year Period with the Employer

From To
The Commissioner of Income Tax (TDS)
Room No. 900A, 9th Floor, K.G. Mittal Ayurvedic Hospital 2022-23 01-Apr-2021 31-Mar-2022
Building, Charni Road , Mumbai - 400002

Details of Salary Paid and any other income and tax deducted

Whether opting for taxation u/s 115BAC No

1. Gross Salary Rs. Rs.

(a) Salary as per provisions contained in section 17(1) 906530.00

Value of perquisites under section 17(2) (as per Form No. 12BA,
(b) 108330.00
wherever applicable)
Profits in lieu of salary under section 17(3) (as per Form No.
(c) 0.00
12BA, wherever applicable)
(d) Total 1014860.00

(e) Reported total amount of salary received from other employer(s) 0.00

2. Less: Allowances to the extent exempt under section 10

(a) Travel concession or assistance under section 10(5) 0.00

(b) Death-cum-retirement gratuity under section 10(10) 0.00

(c) Commuted value of pension under section 10(10A) 0.00

Cash equivalent of leave salary encashment under section 10

(d) 0.00
(10AA)

(e) House rent allowance under section 10(13A) 0.00

Page 1 of 4
Certificate Number: AGIQWTA TAN of Employer: MUMS86151C PAN of Employee: EZLPS3057P Assessment Year: 2022-23

Amount of any other exemption under section 10

(f) [Note: Break-up to be filled and signed by employer in the table
provide at the bottom of this form]

(g) Total amount of any other exemption under section 10 10317.39

Total amount of exemption claimed under section 10

(h) 10317.39
[2(a)+2(b)+2(c)+2(d)+2(e)+2(g)]

Total amount of salary received from current employer

3. 1004542.61
[1(d)-2(h)]
4. Less: Deductions under section 16
(a) Standard deduction under section 16(ia) 50000.00

(b) Entertainment allowance under section 16(ii) 0.00

(c) Tax on employment under section 16(iii) 2496.00

5. Total amount of deductions under section 16 [4(a)+4(b)+4(c)] 52496.00

6. Income chargeable under the head "Salaries" [(3+1(e)-5] 952046.61

7. Add: Any other income reported by the employee under as per section 192 (2B)

Income (or admissible loss) from house property reported by

(a) 0.00
employee offered for TDS

(b) Income under the head Other Sources offered for TDS 0.00

Total amount of other income reported by the employee

8. 0.00
[7(a)+7(b)]
9. Gross total income (6+8) 952046.61

10. Deductions under Chapter VI-A Gross Amount Deductible Amount

Deduction in respect of life insurance premia, contributions to

(a) 418952.00 150000.00
provident fund etc. under section 80C

Deduction in respect of contribution to certain pension funds

(b) under section 80CCC 0.00 0.00

Deduction in respect of contribution by taxpayer to pension

(c) scheme under section 80CCD (1) 0.00 0.00

(d) Total deduction under section 80C, 80CCC and 80CCD(1) 418952.00 150000.00

Deductions in respect of amount paid/deposited to notified

pension scheme under section 80CCD (1B)
(e) 50000.00 50000.00

Page 2 of 4
 Certificate Number: AGIQWTA TAN of Employer: MUMS86151C PAN of Employee: EZLPS3057P Assessment Year: 2022-23

Deduction in respect of contribution by Employer to pension

(f) scheme under section 80CCD (2) 64421.00 64421.00

Deduction in respect of health insurance premia under section

(g) 0.00 0.00
80D

Deduction in respect of interest on loan taken for higher

(h) education under section 80E 0.00 0.00

Gross Qualifying Deductible

Amount Amount Amount
Total Deduction in respect of donations to certain funds,
(i) 0.00 0.00 0.00
charitable institutions, etc. under section 80G
Deduction in respect of interest on deposits in savings account
(j) 0.00 0.00 0.00
under section 80TTA

Amount Deductible under any other provision (s) of Chapter VI-A

(k) [Note: Break-up to be filled and signed by employer in the table
provide at the bottom of this form]

Total of amount deductible under any other provision(s) of

(l) 0.00 0.00 0.00
Chapter VI-A

Aggregate of deductible amount under Chapter VI-A

11. 264421.00
[10(d)+10(e)+10(f)+10(g)+10(h)+10(i)+10(j)+10(l)]

12. Total taxable income (9-11) 687625.61

13. Tax on total income 50025.12

14. Rebate under section 87A, if applicable 0.00

15. Surcharge, wherever applicable 0.00

16. Health and education cess 2001.00

17. Tax payable (13+15+16-14) 52026.12

18. Less: Relief under section 89 (attach details) 0.00

19. Net tax payable (17-18) 52026.12

Verification
I, NILANKA ROY, son/daughter of NRIPENDRA LAL ROY .Working in the capacity of DGM (Designation) do hereby certify that
the information given above is true, complete and correct and is based on the books of account, documents, TDS statements, and other
available records.

Place MUMBAI (Signature of person responsible for deduction of tax)

Full
Date 15-Jun-2022 NILANKA ROY
Name:

Page 3 of 4
 Certificate Number: AGIQWTA TAN of Employer: MUMS86151C PAN of Employee: EZLPS3057P Assessment Year: 2022-23

2. (f) Break up for ‘Amount of any other exemption under section 10’ to be filled in the table below
Particular's of Amount for any other
Sl. exemption under section 10 Deductible Amount
No. Gross Amount
Rs. Rs. Qualifying
Rs.Amount Rs.
1.
2..
3.
4.
5.
6.

10(k). Break up for ‘Amount deductible under any other provision(s) of Chapter VIA ‘to be filled in the table below
Particular's of Amount deductible under
Sl. any other provision(s) of Chapter VIA Deductible Amount
Gross Amount
No. Qualifying Amount
Rs. Rs. Rs. Rs.
1.
2.
3.
4.
5.
6.

MUMBAI (Signature of person responsible for deduction of

Place
tax)
Full
Date 15-Jun-2022 NILANKA ROY
Name:

Document Certified by SBI HRMS Page 4 of 4

NILANKA ROY <dgm.hrms@sbi.co.in>

Digitally Signed by SBI HRMS

NILANKA ROY <dgm.hrms@sbi.co.in>
Date: 2022.06.23 14:01:22 IST